dicumarol and Hematoma--Subdural

A case of lumbar spinal subdural hematoma in a patient who had been on anticoagulant therapy is reported. Thus far 19 cases of spinal subdural hematoma have been reported in the literature, the majority in patients with a bleeding diathesis and after a lumbar puncture. Our case is the third reported to be in association with anticoagulant therapy. The hematoma was lumbosacral, in contrast to the usual location in the dorsal-lumbar area. A possible mechanism for the production of spinal subdural hematoma after a lumbar puncture is discussed. An early decompressive laminectomy and evacuation of the hematoma is the recommended treatment to obtain the best possible recovery of neurological function. (Neurosurgery, 5: 614--616, 1979).

Topics: Dicumarol; Female; Hematoma, Subdural; Humans; Middle Aged; Spinal Cord Diseases; Spinal Puncture

The authors report a series of 22 cases of subdural hematomas in patients submitted to anticoagulant therapy. A review of the literature finds 150 cases. Subdural hematomas occurs in about one third of the patients presenting hemorrhage of central nervous system related to anticoagulant therapy. Among subdural hematomas of any cause, the possible role of a previous anticoagulant therapy is stressed in 4,8 to 14% of cases. In most cases, long term anticoagulants were indicated for arterial or heart (ischemic) lesions (16/22 cases). In 6 cases, anticoagulants were indicated for prevention or treatment of pulmonary embolies. In 18 cases, anticoagulant drug is from the group of dicoumarol or phenylindanedione. In 3 cases, the only anticoagulant given to patient was heparin. Pathogenic study suggests that hypocoagulability might not always be the only factor of bleeding: high blood pressure, other drugs and head trauma (10 cases) are often associated. Clinical features, in our series, are similar to those encountered in cases of subdural hematoma of any cause. According to the existence of a cranial injury and to the chronology of anticoagulant therapy, the authors divide their 22 patients into 3 groups. The use of protamin sulfate or human plasma fraction PPSB provides in few minutes a normal coagulability. Neurosurgical treatment in all our cases evacuated in 11 patients a chronic subdural hematoma, in 2 cases an acute, and in 9 cases a subacute hematoma. Results were fair in 19 patients with no sequelae. 3 patients died during the immediate post-operative period. The authors conclude by stressing several preventive measures.

Topics: Anticoagulants; Cerebral Angiography; Coronary Disease; Craniocerebral Trauma; Dicumarol; Hematoma, Subdural; Heparin; Humans; Phenindione; Pulmonary Embolism

Ten cases of subdural hematoma and one case of spinal epidural hematoma encountered in patients who were receiving anticoagulant therapy are discussed.This surprisingly large number of complications was observed within three years in a single hospital and represents 36.6% of all chronic and subacute subdural hematomas seen during the same period. The cases are analyzed and the conclusion reached that the causal relationship between anticoagulant therapy and hemorrhage cannot be denied.Suggestions are made as to how to decrease the danger of such complications.

Topics: Adult; Aged; Anticoagulants; Cerebrovascular Disorders; Craniocerebral Trauma; Dicumarol; Female; Hematoma, Epidural, Cranial; Hematoma, Subdural; Humans; Male; Middle Aged; Myocardial Infarction; Phlebitis; Recurrence; Spinal Cord Diseases; Spinal Cord Injuries

Topics: Anticoagulants; Cerebral Hemorrhage; Dicumarol; Drug Antagonism; Hematoma; Hematoma, Subdural; Humans; Middle Aged; Spinal Cord Diseases; Thromboembolism; Time Factors

Topics: Aged; Blood Pressure Determination; Brain Abscess; Brain Neoplasms; Cerebral Hemorrhage; Dicumarol; Female; Follow-Up Studies; Hematoma, Subdural; Humans; Intracranial Embolism and Thrombosis; Male; Prothrombin Time; Warfarin

Topics: Cerebral Hemorrhage; Death; Dicumarol; Hematoma, Subdural; Humans

Topics: Cerebral Hemorrhage; Dicumarol; Hematoma, Subdural; Humans